With advanced medical technology, early-stage prostate cancer can still be cured, though it's more difficult. However, if patients receive early treatment, they can prolong their lives. Currently, there are many treatment options for prostate cancer, including cryotherapy, external beam radiotherapy, and chemotherapy. Chemotherapy is suitable for patients who haven't responded to other treatments. When choosing a treatment, it's best to follow the doctor's advice and select the most appropriate treatment for their individual condition.
If prostate cancer is detected early, the cure rate can reach over 95%. Unfortunately, many patients are diagnosed with advanced prostate cancer that has already metastasized. At this point, the disease is already in its advanced stages, and the prognosis is poor. How can prostate cancer be detected early?
Understanding Prostate Cancer
The prostate is a walnut-sized gland found in men, located below the bladder and surrounding the beginning of the urethra. It secretes prostatic fluid, a key component of semen and crucial for fertility. Prostate cancer is a tumor formed by the malignant proliferation of prostate epithelial cells. Early stages are usually slow-growing ("indolent cancer"), but some types can be highly aggressive.
Learn about prostate cancer risk factors and determine who is at higher risk.
Unmodifiable Factors
- Age: The greatest risk factor, with the risk increasing dramatically after age 50.
- Race: African American men are at highest risk, while Asians are at relatively low risk.
- Family History: Having a father or brother with the disease increases one's risk by more than two-fold.
- Presence of specific gene mutations (such as BRCA1/2) also increases risk.
- Hormonal Factors: Prostate cancer cell growth requires the promotion of androgens, which stimulate the proliferation of prostate epithelial cells, thereby increasing the risk of prostate cancer.
Potentially Modifiable Factors
- Diet: A diet high in fat (especially animal fat), red meat, and low in fruits and vegetables may increase risk.
- Obesity: Associated with a more aggressive form of prostate cancer.
- Other: Smoking and exposure to certain chemicals (such as cadmium) may be associated with an increased risk.
Warning: Don't ignore your body's warning signs.
Early Stages
Most cases are asymptomatic! Regular screening is key
(II) Possible Symptoms in the Middle and Late Stages (Symptoms Similar to those of benign prostatic hyperplasia (BPH) and Need to Be Differentiated)
- Urinary Problems: Frequent urination (especially at night), urgency, weak urine stream, straining to urinate, a feeling of incomplete urination, pain or burning during urination.
- Hematuria or Hematospermia: Blood in urine or semen.
- Erectile Dysfunction: May occur.
Symptoms of Late-Stage Metastasis: Bone pain (especially in the back and hips), lower limb weakness or numbness (spinal cord compression), unexplained weight loss, and fatigue.
Screening and Diagnosis Are Key Weapons
- Digital Rectal Examination (DRE): The doctor palpates the prostate through the rectal wall to check for abnormal nodules or changes in texture.
- Prostate-Specific Antigen (PSA) Blood Test: This measures PSA protein levels in the blood. An elevated PSA may indicate prostate cancer, but it can also be seen in prostatitis, benign hyperplasia, and other conditions. Professional interpretation is required.
- Screening Controversy and Individualized Approach: Routine screening is not necessary for all men. Men over 50, or those at high risk due to family history, are advised to make a decision starting at age 45 after a thorough discussion with their doctor about the pros and cons. This helps avoid overdiagnosis and treatment of indolent cancer.
- Diagnostic Methods: If screening results are abnormal (such as an abnormal DRE or a significantly elevated PSA), further testing is required:
① Multiparametric prostate magnetic resonance imaging (mpMRI) precisely locates suspicious lesions.
② Prostate biopsy, which obtains a prostate tissue sample under MRI or ultrasound guidance for pathological examination, is the gold standard for definitive diagnosis. The pathology report will provide important information such as cancer type and grade (Gleason score/ISUP grade group).
The key to defeating prostate cancer: a diversified, personalized treatment strategy
Treatment options are highly dependent on cancer stage and grade, patient age, overall health, and personal preferences:
- Active surveillance/watchful waiting: Suitable for patients with very low-risk or low-risk indolent cancer. Close follow-up (regular PSA, DRE, and repeat biopsies as needed) is recommended, withholding aggressive treatment to avoid overtreatment and side effects. Intervention is only effective if the disease progresses.
- Radical treatment (aimed at curing): Radical prostatectomy, which involves the removal of the entire prostate and some surrounding tissue. This can be performed by open surgery, laparoscopy, or more precisely, robotic-assisted surgery. It may affect urinary control and sexual function, but technology and neuroprotection are constantly improving.
- Radiation therapy: This includes external beam radiotherapy (such as intensity-modulated radiotherapy (IMRT) and proton therapy) and brachytherapy (seed implantation). It can be used alone or in combination with surgery, with efficacy comparable to surgery, and is suitable for patients who are not suitable for surgery. However, it may also cause urinary, intestinal, and sexual side effects.
- Local treatment (still under exploration): Treatments such as cryoablation and high-intensity focused ultrasound (HIFU) are primarily targeted at selected low- to intermediate-risk patients.
- Treatment of advanced/metastatic cancer: Endocrine therapy (androgen deprivation therapy (ADT)) is a core approach, using medications (such as LHRH agonists/antagonists) or surgery (orchiectomy) to reduce androgen levels and inhibit cancer cell growth. Long-term use is often required and may cause side effects such as hot flashes, osteoporosis, fatigue, and metabolic problems. New endocrine drugs, such as abiraterone and enzalutamide, are used for patients resistant to traditional ADT. Chemotherapy, using drugs such as docetaxel, is used for metastatic castration-resistant prostate cancer. Targeted therapies, such as PARP inhibitors targeting specific gene mutations (such as BRCA). Immunotherapy may benefit certain types of patients. Bone health management is also included, and the use of bisphosphonates or denosumab to prevent bone-related events is crucial. Radionuclide therapy, such as radium-223, is specifically used to relieve pain from bone metastases.